Veterinary Guide to Chronic Kidney Failure in Dogs 2025 🩺🐶

By Dr. Duncan Houston BVSc

🧬 What Is Chronic Kidney Failure?

Chronic kidney failure, also called chronic kidney disease (CKD), is a progressive condition where the kidneys gradually lose their ability to filter waste, regulate electrolytes, and control blood pressure, often silently over months or years.

🐕 Common Causes & Risk Factors

• Age-related degeneration, especially in small to medium breeds.
• Inherited predispositions: Bull Terriers, Cocker Spaniels, German Shepherds, Shih Tzus, Samoyeds.
• Chronic infections: Lyme disease, leptospirosis, pyelonephritis.
• Metabolic/endocrine issues: hypertension, diabetes, Fanconi syndrome.
• Toxins: antifreeze, grapes, NSAIDs, some mushrooms.
• Autoimmune glomerulonephritis and cancers.

👀 Signs & Staging

CKD often begins subtly with increased thirst and urination; later, dogs may display:

• Weight loss, reduced appetite, vomiting, diarrhea.
• Lethargy, dehydration, oral ulcers, bad breath, pale gums due to anemia.
• High blood pressure, muscle wasting, and decreased coat quality.

Veterinarians use IRIS staging (I–IV) based on creatinine or SDMA and urine protein to guide treatment.

🔬 Diagnostic Workflow

1. History & Exam: Polydipsia, polyuria, weight loss, oral ulcers.
2. Bloodwork: CBC, chemistry, creatinine, BUN, SDMA.
3. Urinalysis: Specific gravity, protein, sediment, culture.
4. Imaging: Ultrasound or X-rays to evaluate kidney size, structure, stones, tumors, obstructions.
5. Blood pressure: Hypertension is common and requires monitoring.
6. Additional tests: Infectious disease titers, endocrine screening, kidney biopsy for definitive diagnosis.

🛠️ Treatment & Management

💧 Fluid Therapy

• Maintain hydration: fresh water always available; subcutaneous fluids at home if needed.
• Hospitalization with intravenous fluids for dehydration, vomiting, or azotemia.

🥣 Prescription Diet

• Therapeutic kidney diets: low protein, low phosphorus, low sodium, with omega-3s and adequate potassium.
• Commercial options: Hill’s, Royal Canin, Purina Pro Plan renal diets.
• Gradual transition to avoid GI upset.

💊 Medications

• Phosphorus binders: calcium carbonate, aluminum hydroxide to limit hyperphosphatemia.
• ACE inhibitors (enalapril) or ARBs to reduce proteinuria, protect kidneys, and control blood pressure.
• Antihypertensives: amlodipine for persistent hypertension.
• Anti-nausea: maropitant, ondansetron; antacids for gastric ulcers.
• Erythropoietin-stimulating agents or iron supplements for anemia.
• Antibiotics for UTIs, pyelonephritis, or leptospirosis.

⚙️ Supportive Therapies

• Phosphate & potassium monitoring throughout treatment.
• Manage acidosis with alkalinizing agents if needed.
• Update flea/tick/heartworm prevention to protect overall health.

🏡 Home Care & Monitoring

• Offer fresh water and monitor intake/output daily.
• Track appetite, vomiting, stools, and weight weekly.
• Regular blood tests and blood pressure checks every 2–6 months.
• Avoid toxic foods and medications; keep toxins out of reach.

📱 Ask A Vet Ecosystem Support

• Telehealth Reviews: Share lab results, dietary logs, and weight trends remotely.
• Fluid & Medication Reminders: Scheduled notifications for subQ fluids, meds, BP checks.

🎓 Case Spotlight: “Lucy” the Senior Terrier

Lucy, a 12‑year‑old Terrier mix, began drinking and peeing more, lost 10% body weight, and had intermittent vomiting. Labs identified stage III CKD (creatinine 2.2 mg/dL). We started subQ fluids, switched to renal diet, added enalapril and maropitant. Four months later, her energy and appetite improved, labs stabilized, and she remained stable six months later with regular home care and remote Ask A Vet support.

⌛ Prognosis & Quality of Life

• CKD is incurable—focus is on slowing progression and preserving life quality.
• Early-stage (I–II): potentially live years with management.
• Mid-stage (III): quality life is possible with meds, diet, and hydration.
• End-stage (IV): more intensive management; palliative care if needed.

🔚 Key Takeaways

1. CKD is gradual—early signs like thirst and urination matter.
2. Diagnosis uses bloodwork, urine, imaging, and BP checks.
3. Care includes hydration, renal diet, meds, and toxin avoidance.
4. Routine monitoring and telehealth support from Ask A Vet improve outcomes.
5. With attentive care, many dogs enjoy a great quality of life for years after diagnosis.

Dr Duncan Houston BVSc, founder of Ask A Vet. Download the Ask A Vet app now for kidney disease guidance, remote monitoring, and personalized care tools—keeping your pup safe, comfortable, and thriving! 🐶❤️